Exploring a roadmap to achieving tobacco endgame in sub-Saharan Africa: A qualitative study among stakeholders from 12 countries

Abstract

ABSTRACT Introduction Tobacco endgame seeks to bring an end to tobacco use or drastically reduce prevalence to <5%. Discussions about tobacco endgame and the possible strategies to achieve this goal in Sub-Saharan African (SSA) are sparse. This study aimed to explore SSA tobacco control stakeholders’ perspectives about tobacco endgame and ascertain what strategies they perceive to be suitable for the region to achieve this. Methods This was a qualitative study involving a purposive sample of 29 stakeholders interviewed via online platforms guided by a semi-structured interview schedule. Stakeholders were from academia, civil society, and government departments in 12 SSA countries. Interviews were conducted in English or French, transcribed verbatim (those in French were translated to English) and thematically analyzed with the aid of NVIVO v12. Results There is support for the adoption of tobacco endgame in SSA by tobacco control stakeholders in in the region due to the impact tobacco has on health, the environment and economy. Proposed endgame approaches for SSA were recommended to be Afrocentric which must be sensitive to cultural and regional dynamics. Stakeholders believed that the success of endgame strategies depends on political will, multi-sectoral collaboration, availability of resources, buy-in from the public and tobacco industry monitoring. Suggested endgame strategies were categorized into 5 themes: Product-focused (less addictive tobacco and regulation of novel products); User-focused (smoke-free generation, cessations supports and use of sports); Market/supply-focused (licensing of sellers, increase in taxes, control of illicit trade and alternative income for farmers); Institutional structure-focused (tobacco industry monitoring and regulation) and legislation implementation-focused (effective implementation of international treaties aimed at lowering tobacco use prevalence). Conclusion There is support for a tobacco endgame in SSA. Collaboration from various departments/ministries, and support from government and the public would be needed to make tobacco endgame a reality in SSA. Key Highlights Discussion on how to end tobacco use (endgame) in Sub-Saharan African (SSA) is sparse. Tobacco control stakeholders in SSA are supportive of tobacco endgame for the region. Afrocentric endgame strategies sensitive to culture and countries’ peculiarities are needed. User, product and supply focused, as well as institutional and legislation focused strategies have been proposed. Proposed endgame strategies must include alternative income for farmers and cessation support. Support from SSA governments and the public, and tobacco industry monitoring are needed for successful implementation of tobacco endgame in SSA.